Affidavit of Consent -Permit

REPUBLIC OF THE PHILIPPINES ) Muni Munici cipa palility ty of Talib alibon on ) S.S. S.S.

AFFIDAVIT OF CONSENT I, _____________   _____________ , Filipino, of l!al a!, an" a #$i"nt of %%%%%%%%%%%%%%%%, %%%%%%%%%%%%%%%%, P&ilippin$, P&ilippin$, &a'in! bn "uly $(o#n in acco#"anc (it& la(, &#by "po$ an" $tat *. T&at I a+ on on of t& &i#$ &i#$ of Spou$$ Spou$$ %%%%%%%% %%%%%%%%%%%% %%%%%%%% %%%% (&o (&o o(n" o(n" a pa#cl pa#cl of lan" (it& (it& T No. %%%%%%%%%%%. T&at +y $i$t# $i$t# %%%%%%%% %%%%%%%%%%%% %%%%%% i$ applyin! applyin! fo# a Buil"in! Buil"in! P#+it P#+it at t& Offic Offic of t& MPC of t& Municipality of %%%%%%%%%% $o $& coul" buil" a #$i"ntial &ou$ on a po#tion of t& afo#+ntion" afo#+ntion" pa#cl of lan"/. T&at I &#by &#by $i!nify $i!nify +y (#ittn (#ittn con$nt, con$nt, f#ly f#ly,, (illin!ly (illin!ly an" 'olunta#i 'olunta#ily ly to allo( +y $i$t# $i$t#  %%%%%%%%%%%%%%  %%%%%%%%%%%%%% to buil" &# #$i"ntial &ou$ on a po#tion of t& $ai" pa#cl of lan" l an" an", con$0untly, &a' an lct#ic connction on &# &ou$1. T&at T&at I a+ 2cu 2cutitin! n! t&i$ t&i$ affi affi"a "a'i 'itt to att$t att$t t& t#ut& t#ut& of t& fo#! fo#!oi oin! n! fact$ fact$ a$ to +y un"#ta3in! to !i' con$nt to +y $i$t# %%%%%%%%%%%%%% to $uppo#t &# application fo# a Buil"in! P#+it an" Elct#ification P#+it. IN WITNESS WITNESS WHEREOF WHEREOF, ( &a' &#unto $t ou# &an"$ t&i$ */ t&  "ay of 4p#il 5*6 at

 %%%%%%%%%%%%%%%%  %%%%%%%%%%%%%%%%,, P&ilippin$.

 

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4ffiant SUBSCRIBED AND SWORN  to bfo# +, t&i$ */t& "ay of 4p#il 5*6 5* 6 at %%%%%%%%%%%%%%%%%%%%. %%%%%%%%%%%%%%%%%%%%.